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If the latest attempt to repeal and replace the Affordable Care Act is successful next week, more than 400,000 people in Kentucky who have health insurance through the Medicaid expansion would lose their coverage.

The Graham-Cassidy bill currently under consideration would cut federal funding for the Medicaid expansion program – which covers people making a little above the poverty line – by 2026.

“All funding for Medicaid expansion disappears,” warned Third District Congressman John Yarmuth at a press event Thursday.

But the repeal wouldn’t just affect those expansion enrollees. The majority of people in Kentucky who have Medicaid are covered under the original program: usually because they either live in poverty or have a disability. If the Graham-Cassidy bill passes, it would place a cap on state Medicaid spending. This would mean when the money runs out, the care runs out.

Right now, if a person with Medicaid health insurance goes to the doctor, the federal government pays for almost 80 percent of that visit — the state picks up around 20 percent. There are no caps on the number of doctor visits, or on how much money Medicaid will reimburse per year.

But under Graham-Cassidy, that would change. Kentucky and other states would get one lump of money, per person, to spend per year.

Yarmuth said that won’t keep up with the rising cost of medical services and could likely lead to cuts.

“Then you cut in absolute terms and you have more people entering the system and you have costs rising — you’re covering fewer people or you have to cut benefits, one way or the other,” he said.

There are many other provisions that would also be cut under Graham-Cassidy, like subsidies to buy insurance on Healthcare.gov and certain benefits with those plans including maternity coverage, and guaranteed pre-existing condition protections.